MediQHome Quality Program

Region Within State: 
Statewide
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Thursday, January 1, 2009

On January 1, 2009, Blue Cross Blue Shield of North Dakota (BCBSND) launched the MediQHomesm Quality Program statewide in North Dakota. After extensive consultation internally and with providers across the state, the program was designed to support the delivery of collaborative care coordination by providing custom-designed information technology and a decision support tool (MDinsightTM), along with an innovative reimbursement mechanism.

By October 2011, 71 percent of all North Dakota providers were participating in the program and 74 percent of BCBSND members were in MediQHomesm.  Not only does the program have the potential to benefit everyone in the state, it also acts as a limited health information exchange (HIE) and allows access to quality reporting and measurement.

How MediQHomesm Works

Unlike traditional disease management programs that focus on the disease, MediQHomesm focuses on the patient and quality of life. Patients select a primary care provider who becomes their medical home, and that provider keeps track of all the patient's health information, coordinates care with other providers and serves as a single source of information about the patient's condition.

Providers use MDinsightTM to identify care opportunities. The tool organizes all available patient clinical data in one place so providers spend less time searching for information and more time with patients. Today, the program tracks 14 clinical suites:

  • Asthma
  • Attention deficit hyperactivity disorder (ADHD)
  • Chronic heart failure
  • Coronary heart disease
  • Adult diabetes
  • Adolescent diabetes
  • Child diabetes
  • Adult hypertension
  • Adolescent and child hypertension
  • Breast cancer screening
  • Cervical cancer screening
  • Colorectal cancer screening
  • Adult and adolescent immunizations
  • Child immunizations
Type of Practices: 
Other
CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Blue Cross Blue Shield of North Dakota
Primary Contact: 
Petrice Balkan, Program Manager
E-mail: 
[email protected]
Phone: 
701-277-2336
Additional Contact
Name: 
David Hanekom, M.D., Vice President and Chief Medical Officer
Phone: 
701-282-1350
Participating Stakeholders: 

Blue Cross Blue Shield of North Dakota and self-funded employer groups

Participating Organization Types: 
Primary care practices and integrated delivery systems
EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
23
Number of Participating Physicians: 
840
Physicians per practice: 
Varies from 1 to over 300
Types of Practices: 
Multi-specialty
Health Plan Lines of Business Included: 
All patients regardless of their health plan are included
Overall Number of Covered Lives: 
250000
Technology Characteristics at Start of Pilot: 

Varies from paper record system to electronic medical records

Consumer Involvement: 

More participation in medical decision making; alerted to recommended screenings; better control over symptoms

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 
  • Access to care
  • Care coordination and team-based care
  • Use of a custom-designed information technology and decision support tool (MDinsightTM)
Services participating practices have added as a result of their participation: 
  • Care coordination teams
  • Integrated behavioral health with primary care
  • Quicker adoption of electronic medical records
  • Chronic disease follow-up and free home visits, etc.
Technology that participating practices have added as a result of their participation: 

Access and use of the MDinsightTM platform

Payment Model: 

In 2010, reimbursement methodology rewarded providers for participation in the MediQHomesm program with a care management fee (CMF). BCBSND modified the 2011 reimbursement methodology to facilitate more robust care coordination, improved quality of care and closer adherence to evidence-based treatment standards for all patients.

  • The CMF is risk-adjusted based on the number of targeted conditions a member has (single versus multiple) as members with multiple conditions require additional resources for coordinating and managing their conditions.
  • The CMF amount for the second semi-annual payment in 2011 will be additionally adjusted for each eligible member based on the performance of the provider organization in designated quality metrics. This allows for a 15 percent adjustment in the base CMF determined by pre-defined quality tier achievement by providers.

For 2011 quality tiers, performance levels have been established for measuring optimal diabetes care, optimal vascular care and blood pressure control (adult hypertension).

PROJECT EVALUATION
Types of data to be collected : 

78 various process and outcome metrics that apply to the 14 clinical suites

Which of the data types are being shared?: 

All clinical data for the 14 clinical suites are shared, including some claims data. Additionally, clinical quality measures are based on both process and outcome measures, utilization data and medical cost data.

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

All clinical data for all patients, regardless of insurer, are uploaded to MDinsightTM. This allows the providers to provide total practice management using the MDinsightTM platform. The data is patient-centric and can be viewed by any treating provider regardless of whether they belong to the same organization.

Results to Share: 

Clinical and financial outcomes were presented by David Hanekom, M.D., BCBSND Chief Medical Officer, at the PCPCC 5th Annual Summit on October 21, 2011, in Washington, D.C. Click here to view his presentation.

Relevant links: 

MediQHome.com - see the MediQHomesm Difference, access additional information relevant to providers, clinical and financial outcomes, access the MediQHomesm Annual Report